cong sy (1996). Nhiem khuan hd hip tren cap tinh dtreem Vi§tNam.Oetii KY01 -10 Bd Y t i Hi Ndi, 20-21.
5. Nguyin HQ'u Khoi (1996). Nhiim khuan i i khi trong viem tai giu-a mu man tinh v i dinh g i i mCre dd nhay cam vdi mdt so khing sinh, Ndi san Tai Mui Hpng (2), Hdi Tai Mui Hpng Viet Nam, H i Ndi, 45 - 48.
6. Dinh Thj Thu Hu-ang (2001). Nghien eu-u lim sing, vi khuan trong viem tai giu-a man tinh d tre em v i vin d i d i khang khing sinh hien nay tai Vien Tai Mui Hpng, Luin van tdt nghidp bic sy chuyen khoa cip II, Dai hpc Y H i Ndi.
7. Barnett ED, Klein JO (1995). The problem of resistant bacteria for the managemetn of acute otitis
media, Pediatr Clin North Am; Vol: 42: 509 -17.
8. BMJ (2000). Quinolone for ear drop for otitis media. Vol: 321, 126 -127 (15 July). From InterneL
9. Dagan R (1998). Can the choice of antibiotics for therapy of acute otitis media be logical?. European Journal of Clinical Microbiology and Infectious Diseases; 17: 15.
10. Gruneberg RN, Felmingham D (1996).
The Alexander Project Group. Result of the Alexander Project: A continuing, multieenter study of the antimicrobial susceptibility of community accquired lower respiratory tract bacterial pathogenes.
Diagnostic Microbiology and Infectious Disease;
Vol: 25, 169-181.
Summary
IDENTIFYING THE COMMONEST MICROORGANISMS ASSOCIATED WITH CHRONIC DISCHARGING EARS BY CHILDREN AND THEIR ANTIMICROBIAL
SENSITIVITIES
Identify the commonest microorganisms associated with chronic discharging ears by children and their antimicrobial sensitivities. Method: Descriptives tudy.This study was carried out from 01/02/2010 to 31/03/2010 in the outpatient deparment of the national ENT Hospital A total of 38 patients with unilateral or bilateral active chronic suppurative otitis media attending the outpatient clinic were included in the study. All patients were evaluated through detailed history and clinical examination. Result: Overall microbiology of 38 samples was studied of which 78.95%o positive cases. Pseudomonas aeruginosa accounted for 28.12%
was the most common isolate, followed by Moraceila catarrhalis: 25%). Then followed by Staphylococcus aureus (21.87%) and Hemophilus Influenzae (15.62%o). Antibiotics sensitivities pattern showed that majority of these bacteria are resistant to most common antibiotics. Conclusion: Commonest organisms isolated from chronic discharging ears were Pseudomonas aeruginosa and Staphylococcus aureus. Majority of isolates of Pseudomonas aeruginosa were sensitive to Amikacin and Ciprofloxacin. The 2"''and 3'''' Cephalosporins and Amox/clavulanie were effective against most of the isolates of those microorganisms.
Keywords: chronic suppurative otitis media, microbiology, antibiotic sensitivity
TY LE MAC, TO' VONG VA MOT S6 YEU TO LIEN QUAN CLiA VIEM P H 6 I THCy MAY
Le Kiin Ngai, Khu Thj Khanh Dung Benh vidn Nhi Trung wong
Nghidn ciru nhdm xdc dinh ty Id mdc, ty Id mdc mdi, ty Id tw vong cua vidm phdi thd mdy (VPTM) vd md td m0t s6 yiu t6 lidn quan tdi VPTM tai cdc khoa hdi sire tich cux: bdnh vien Nhi Trung wong. Kit qud: 120 b$nh nhdn thd mdy dO tidu chuin nghien ciru, vdi tdng s6l162 ngdy thd mdy; Ty Id mdc 26,7%; ty 1$ mdc mdi 27,5/1000 ngdy thd mdy; t^ Id tw vong 46,7%; Lidn quan giCra VPTM vdi gidi (OR = 1,3; p > 0,05); vdi tudii 1 tuin vd > 1 tuin (OR = 0,65; p > 0,05); vdi khoa diiu trjx^ = 3.05; p > 0,05); vdi chin dodn luc vdo vidn:
TCNCYH Phu trwong 74 (3) - 2011
sa sinh non thing (OR = 0,91; 95%,CI: 0,38 - 2,17), benh tim mach (OR = 1,0; 95%,CI: 0,25 - 3,96),bpnh hd hip (OR=1,83;
95% CI: 0,77 - 4,34), NKH (OR = 2,37; 95%CI:2,69 - 9,13); vdi dudng dat NKQ (OR = 2,71; p > 0,05); vdi thdi gian thd miy > 4 ngay (^ = 5,5; p = 0,018. 75% VSV phin lap dwac la vi khuan Gram (-), hang diu la P. aemginosa. Kit luin: Ty le mic, ty Ip mac mdi, ty le tir vong VPTM cao. Budc diu thiy VPTM lien quan vdi thdi gian thd may tren 4 ngiy.
Tir khoa: viem phoi tho- may, ty le mic, mic mai, tu- vong, lien quan
I. DAT
VANDfe
Vidm phoi thd miy (VPTM) l i mdt trong nhu-ng loai nhiim khuan mic phai thudng gap nhit trong benh vidn, lim trim trpng them tinh trang benh, kdo dii thdi gian thd miy, thdi gian nim vien, ty Id tu- vong ting len v i ting cie ehi phi trong benh vien [5, 8, 9].
Theo nghien cCru d eic nude phit trien, VPTM xay ra trong 10 20%o trong so cie benh phai thd miy tCr 48 gid trd len [2]. Ty Id tu- vong tCr 24 - 50%
v i ting len d i n 76%) niu can nguyen l i cie vi khuin da khing vdi khinh sinh [3]. Benh nhin mie VPTM ed kha nang tu- vong cao gip hai lan so vdi benh nhin khdng cd VPTM [6]. Tai eic dan vj hdi su-c cip eCru tre em ty Id VPTM chiim 3,3%
tong sd benh nhin nhip vidn; 5,1%) tong sd benh nhin thd miy v i ty Id mic mdi l i 11,6/1000 ngiy thd miy [5]. Trong khi dd d c i e quoe gia dang phit triin cho din nim 2007 chi cd khoang 15 nghien eCru v i VPTM dugc xuit ban [1, 7]. Trong dd chf ed 1 nghien eCru dugc thye hien d Ddng Nam A.
Hiu hit cie nghidn cu-u chl de cap din vide x i c djnh ty Id xuit hien (proportion) v i ty suit mie mdi (incidence rate) VPTM [1, 7].
Cy Viet Nam VPTM eung l i loai nhiem khuin benh vien du-ng hing d i u [10,11], tuy nhidn ehua cd cie nghien eCru d i cap din ty Id m i c mdi, ty Id tu- vong v i eic y i u td nguy ea cua VPTM. Bdnh vien Nhi Trung uang, nai tiep nhin benh nhi nang tCr t i t ea eic tuyin trong ca nude cd khoang 100 benh nhin thd miy/ngiy v i ed nhiiu nguy ea xuat hidn VPTM. Hieu b i i t ' v i thye trang VPTM tai benh vien bao gdm ty Id mac, ty Id tu- vong v i cac y i u td nguy ea l i ea sd d i canh bio v i phdng ngCra VPTM tai benh vien vdi muc tieu: X i c djnh ty Id mie, ty Id mdi mie, ty Id tu- vong eua VPTM. Md ta mdt so yiu td lien quan tdi VPTM tai eic khoa hdi sCrc tich eye benh vien Nhi Trung uang.
II.
D 6 ITU'QNG vA PHU'QNG
P H A P I.Dia diimNghien cu-u dugc tiin hinh tai ba khoa Hdi sCrc cap eu-u (HSCC), Hdi sO-e sa sinh (HSSS) v i Hoi sCrc Ngoai khoa (HSN) benh vieri Nhi Trung uang.
2. Thd'i gian
TCr thing 1/2009 d i n thing 2/2009.
3. Ddi tu'ang
3.1. Quin thi nghien cwu: T i t ea cie benh nhin dugc thdng khi hd trg bing miy thd, diiu trj tai 3 khoa hoi sCrc tich cue Benh vien Nhi Trung uang
3.2. Tieu chuin Iwa chon: Benh nhin nhip vi§n thoa man cac dieu kidn.
- Dugc dat ndi khi quan tai khoa v i thd miy tir 48 gid trd len.
Ouge dat ndi khi quan trong vdng 24 gid trudc khi nhip v i o khoa v i dugc thd miy tai khoa tir 48 gid trd len.
3.3. Tieu chuin loai trw
- Benh nhin thd miy dudi 48 gid.
Benh nhin dugc d i t NKQ tir 24 gid trd len trude khi nhip vao khoa.
4. Phu'ang phip
4.1. Thiit ki nghien cwu: md ta, tiin eu-u.
4.2. Tieu chuin xac djnh VPTM: theo tidu chuan cua Trung t i m kiim soit benh t i t - Hoa Ky (CDC) nam 2004, bo sung nam 2008.
4.3. Cac biin so va chi so nghien cwu - Cac biin nhim x i c djnh ea benh VPTM: tinh trang sdt/ha nhiet dp; nhjp tim; tinh chit ddm; ran phoi; tinh chit thdng khi; sd lugng bach cau (SLBC); d i u hidu tren phim X - quang phoi...
- Cie biin ty Id: ty Id mie; ty Id mie mdi; ty 10 tu- vong.
Cie biin phai nhiim d i do ludng kha ning lam ting nguy ea xuit hidn VPTM: tuoi; gidi tinh;
chin doin luc nhip vidn; khoa diiu trj; so ngiy thd miy; dudng dat ndi khi quan (NKQ).
4.4. Thu thap so lieu: Sd lidu dugc thu thip bing bdnh i n nghidn eCru. Mdi bdnh nhin dugc theo ddi hing ngiy tir ICie dugc d i t NKQ cho din khi: benh n h i n t h o i t i n g NKQ v i 48 gid liin sau
do hoic bdnh nhan tu- vong.
4.5. Phan tich so lieu: Ty Id mie dugc tinh bing so VPTM/ tong sd benh nhin thd miy; ty Id mie mdi l i sd VPTM/1000 bdnh nhin ngiy thd miy. Do ludng eic biin dugc coi l i phai nhiim (bao gom tuoi, gidi, chin doin luc nhip vien, khoa, dudng dit NKQ, so ngiy thd miy) anh hudng tdi nguy ea xuit hidn VPTM bing ty suit chenh (OR) hoic nguy ca tuang ddi (RR) vdi khoang tin eiy (CI) 95%; hoic kiim djnh x^ vdi g i i trj p, y nghTa d mu-c < 0,05. Nhip sd lieu bing phin mim Excel v i xu- ly bing phin mim SPSS.
III. K^T QUA
1. DQ' lieu ca ban v l miu nghien cu'u: 574 benh nhin dugc nhip vao ba khoa hdi sCrc trong thdi gian bin tuin thu thip sd lieu vdi tong so 4001 benh nhin ngiy nam vien. Cd 170 benh nhin thd miy trong thdi gian theo ddi; 50 benh nhan da thoit may v i thd miy (TM) dudi 48 gid.
S6 trudng hgp du tieu chuin lya chpn l i 120, vdi tong so 1162 ngay thd may trong dd tre trai 81 (67,5%). Khpa Sa sinh 79 (65,8%) v i 709 ngiy thd
miy (61%); Khoa HSCC 24 (20%) va 187 ngiy thd miy (16,1%); Khoa HSN 17 (14,2%) v i 266 ngiy thd miy (22,9%).
2. Ty le mic, ty le mo-i mic VPTM: Cd 32 trudng hgp VPTM xuit hidn trong thdi gian theo ddi.
Ty Id mic VPTM trong nghien eCru niy l i 32/120 (26,7%); ty Id mdi mie 32/1162 bdnh nhin - ngiy TM (27,5 VPTM/1000 benh nhin - ngiy TM). Thdi gian thd miy trung binh eua 120 benh nhan nghien eCru la 11,8 ngiy; d benh nhan cd VPTM l i 15,2 ngiy; d benh nhan khdng cd VPTM l i 8,0 ngiy.
3. Ty le tu- vong ciia VPTM: Cd 92 benh nhin dugc theo ddi din khi tu- vong hoic thoit miy v i it nhit 48 gid sau thoit miy. Thdi gian trung binh tCr ICic VPTM xuit hien din khi benh nhan tCr vong la 5,18 ngiy. Ty Id tu- vong eua VPTM dugc ghi nhin trong nghien cu-u niy l i 46,7%, khic biet ed y nghTa thing ke so vdi benh nhan khdng cd VPTM (6,5%) (RR = 7,23; CI: 2,6 - 20,1) v i tuang ty nhu kit qua d i cdng bd cua cac nghien eCru tai cie nude phit triin (5). Benh nhin thudng tu- vong vio ngiy thCr 6 sau khi xuit hien VPTM. Do ludng cac yiu td cd kha nang lien quan din VPTM.
Bang 1. Tudi va kha nang xuit hien VPTM
Tuii VPTM (%) Khdng VPTM (%) OR [95%,CI]
Tuoi ^ 1 tuin 17(23,3) 56 (76,7)
Tuii > 1 tuin 15(31,9) 32(68,1) 0,65(0,26-1,59]
p > 0,05 Tong so
Khoa Sa sinh HSCC HSN
Bang
VPTM {%) 17(31,5)
9 (37,5) 6 (35,3)
32 88
2. Khoa benh nhan nim vien va kha nang xuit hien VPTM
Khdng VPTM (%) 62 (78,5) 15(62,5) 11 (64,7)
Bang 3. Du'd'ng dat NKQ
Ty le md'i mic VPTM (/i000 ngay TM)
24,0 48,1 22,6
OR 1,0 2,19
1,99 va kha nang xuit hien VPTM
x^P X' = 3,05 p = 0,081
Du'ang dat NKQ* VPTM (%) Khdng VPTM {%) OR [95%CI]
Dudng mui 8 10
Dudng midng 23 78 2,71 [0,85-8,61]
p > 0,05
Tong sd 31 88
": c6 01 bdnh nhin dugc d i t NKQ qua md khi quan.
4.4. Cdn nguyen gay benh
TCNCYH Phu trwong 74 (3) - 2011
Bang 4. Vi sinh vat tim thiy du'ac tip djch hut NKQ ciia benh nhan VPTM
Vi sinh vat n (%)
Vi khuin Gram i m P. aeruginosa A. baumanii K. pneumoniae S. maltophilia E. meningiseptica
7 5 2 2 1
35,0 25,0 10,0 10,0 5,0 Vi khuan Gram duang
S. viridans S. aureus
1 1
5,0 5,0 Nim
C. albicans Tong sd
1 20
5,0 100
V. BAN LUAN
Trong hoin canh ed khdng nhiiu eic nghien cCru v i nhiem khuin benh vien d tre em trong dd cd VPTM dugc thye hien d eic qudc gia dang phit triin, kit qua nghidn eCru d i udc doin dugc mdt v i i chl so ed y nghTa trong viec d i xuit cie bidn phip dy phdng eung nhu ggi y eic hudng nghien eu-u mdi v i VPTM trong cie bdnh vidn tre em d Viet Nam eung nhu khu vyc Ddng Nam A.
V l ty le mic, ty le mic mai, ty le tii' vong va thd'i gian benh nhan phai thd' may keo dai
Ghi nhin dugc 26,7%) trudng hgp cd VPTM trong so 120 thd miy dugc theo ddi. Cao han nhiiu so vdi kit qua (5,1%)) tai eic khoa hdi su-c nhi v i hoi su-e sa sinh cua benh vidn Tre em SLLouis, Oai hpc Washington [5]. Tuy nhien tre sa sinh non thing tai benh vien ndi trdn cung cd ty Id VPTM khi cao 28,3% (2). So vdi k i t qua nghien eCru tai Saudi Arabia (20%o) diy khdng phai l i mdt ty Id q u i cao [3].
Ty Id mdi mie,VPTM cua nghien eCru niy (27,5/1000 ngiy TM) cao han gip 2 lin so vdi nghien cu-u eua Elward tai Dai hpc Washington (11,6/1000 ngiy TM) [6].
V l mot s6 yiu td co kha nang lien quan din VPTM
- Mie du trong thdi gian nghien eu-u, benh nhin tai khoa Hdi su-e cip cCru cd ty Id mic v i ty Id mdi mie VPTM cao nhat (37,5% v i 48,1/1000 ngiy thd
miy) nhung khdng cd sy khac biet giu-a 3 khoa.
Cd t h i dy doin rang thuc hinh chim sdc, diiu trj benh nhin tai 3 khoa Sa sinh, HSCC va HSN la tuang ty nhau doi vdi sy xuat hien VPTM.
Vdi sd lieu da thu thip dugc chua tim thiy moi lien quan giii-a chin doin luc vio vien bao gdm sa sinh de non, nhdm bdnh tim mach, nhom benh hd hip, nhidm khuan huyet vdi sy xuit hien VPTM, mie dCi benh nhin mie nhiim khuan huyit v i benh hd hap ed ty Id xuit hipn VPTM cao nhit (41,7% v i 29,9%; 33,1/1000 ngiy thd miy va 31,5/1000 ngiy thd miy). Trong khi dd eic nghien eCru eua Elizabeth, Elward v i Apisarnthanarak ehCrng minh ed mdi lien quan giu-a NKH trude do, tuoi thai dudi 28 tuin vdi VPTM [2, 5, 6].
Mdt sd nghien eu-u ed d i cap din vide dat NKQ dudng mui ed nguy ca lim xuit hien VPTM nhiiu han dudng midng. Tuy nhien, khdng thay c6 mdi lien quan ed y nghTa vdi sd lieu d i ed.
Vdi thdi gian thd miy tCr 4 ngiy trd len v i sau dd cang thd miy d i i ngay thi kha ning xuat hidn VPTM cing Idn. Theo Elizabeth niu benh nhin thd may trdn 3 ngiy kha ning mic VPTM l i 1,17 lin (OR) vdi p < 0,015 v i khoang tin eiy 1,15-1,19 [2].
V l cac vi sinh vat phat hien du'ac
Hau hit phin lip dugc vi khuan Gram i m trong eic benh pham djch hut NKQ, trong dd hing diu la P.aeruginosa (35%)). K i t qua tuang ty nhu cie nghidn eu-u khic [2, 5).
Han che ciia nghien cu'u
Cd khd khin trong vide i p dung tidu chuin chin doin eua CDC trong vide x i c djnh ea bdnh.
Chi ed 17 trudng hgp phu hgp hoin toin vdi tieu chuan chin doin. Cie trudng hgp khic dugc coi li ca benh VPTM niu eic biiu hien lim sing phu hgp nhung khdng ed phim XQ phoi hoic ngugc lai.
Thdi gian nghidn eCru ngin cho nen cd mau thu thip dugc ed t h i ehua mang tinh dai dien hoan toin cho quan the nghien eCru.
VI. K^T LUAN
Vdi dCr lidu thu thap dugc tai eic khoa hdi sCre cip cCru benh vidn Nhi Trung uang trong thdi gian nghien cu-u cho thiy ty Id mic va ty Id mic mdi VPTM d mu-e cao (26,7% sd bdnh nhan thd miy va 27,5/1000 benh nhin ngiy thd miy); gin mdt nu-a benh nhin mic VPTM tu- vong trong thdi gian diiu tri (46,7%); benh nhan thudng tu- vong vio ngiy thCr 6 k i tCr khi xuit hien VPTM.
Trong pham vi nghien cu-u chua thiy VPTM cd lien quan vdi gidi, tuoi, chin doin luc nhip vien, khoa diiu trj, dudng dit NKQ nhung ed lien quan vdi thdi gian bdnh nhin phai thd miy. Thdi gian thd miy trung binh eua c i e benh nhin thd miy trong nghien eu-u l i 11,8 ngay; eua nhdm ed VPTM la 15,2 ngiy v i nhdm khdng ed VPTM l i 8 ngiy.
Chu yiu phin lip dugc cie vi khuin Gram i m , hing diu l i P.aeruginosa trong dich hut NKQ cua b^nh nhin VPTM.
TAI
LIEU THAM
K H A Q1. Abramczyk ML, Werther MC, Carvalho E, Medeiros EA. Nosocomial Infection in a Pediatrie Intensive Care Unit in a Developing Country. The Brazilian Journal of Infectious Diseases; 7 (6):
375 - 80 [3].
2. Apisarnthanarak, A., G.Holzmann - Pazgal, A. Hamvas, M. A. Olsen, and V.J.Fraser. (2003).
Ventilator associated pneumonia in extremely preterm neonates in a neonatal intensive care unit:
characteristics, risk factors, and outcomes.
Pediatrics 112: 1283-1289.
3. Almuneff, M.,Z.A. Memish, H. H. Balkhy, H.AIalem, and A. Abutaled, (2004). Ventilator
associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30 month prospective surveillance. InfcL Control Hosp. Epidemiol. 25:
753 - 8 [4].
4. Chastre J, Fagon JY. Ventilator - associated pneumonia. Am J Respir Crit Care Med 2002; 165:867-903(11].
5. Elizabeth Foglia, Mary Dawn Meier, and Alexis Elward (2007). Ventilator Asoociated Pneumonia in Neonatal and Pediatrie Intensive Care Unit Patients. Clinical Microbiology Review:
409-425(18].
6. Elward, A.M.,D.K. Warren, and V. J.Fraser.
(2002). Ventilator - associated pneumonia in pediatrie intensive care unit patients: risk factors and outcomes. Pediatrics 109: 758 - 64 [20].
7. Safdar N, Dezfulian C, Collard HR, Saint S (2005). Clinical and economic consequnces of ventilator - associated pneumonia: a systematic review. Crit Care Med; 33: 2184 - 2193 [49].
8. Thongipiyapoom S, Narong MN, Suwalak N, Jamulitrat S, Intarasksa P, Boonrat J, et al (2004). Device - Associated infections and patterns of antimicrobial resistance in a medical surgical intensive care unit in a university hospital in Thailand.
Journal of the Medical Association of Thailand. 87 (7): 819-24. 23 [55].
8. Turton P (2008). Ventilator associated pneumonia in paediatric intensive care: a literature review. Nursing in Critical Care. 13 (5):241 - 7.4. [57].
9. Wright ML, Romano MJ (2006). Ventilator - Associated pneumonia in Children. Pediatric Infections diseases journal. 4(3):58 - 64 [62].
10. Ha Manh Tuin (2006). Yiu td nguy ca v i tic nhin giy nhiim khuin benh vidn tai Khoa Hoi su-e c i p eCru Benh vien Nhi ddng I. Luin i n Tiin sy Y hpc. Trudng dai hpc Y, Dugc Thinh pho Hd Chi Minh,
11. Le Kiin Ngai, Khu Thj Khanh Dung (2005). Ty Id nhidm khuan benh vien v i mdt sd yiu td lien quan tai Bdnh vien Nhi Trung uang. Dai hpc Y H i Ndi. Tap chi nghien eCru Y hpc phu truang so 38 (5): 206-210.
TCNCYH Phu trwong 74 (3) - 2011
Summary
THE INCIDENCE, RISK FACTORS AND OUTCOME OF VENTILATOR ASSOCIATED PNEUMONIA
Objectives: To identify the incidence, proportion, outcome of VAP; To describe some risk factors to VAP in three intensive care unit - NHP. Results: 120 patients under MV fit criteria, there were 1162 ventilators days in total; The proportion was 26.7%); The incidence was 27.5/1000 ventilators days; Mortality rate was 46.7%; Association between VAP and gender (OR = 1.3; p > 0.05); Age < 1 week and > 1 week (OR = 0.65; p > 0.05); ward (x^ = 3.05; p > 0.05); admission diagnosis: premature newborn (OR = 0.91; 95%CI 0.38 2.17), cardiovascular problems (OR = 1.0; 95%CI: 0.25 3.96), respiratory problems (OR = 1.83;
95% CI: 0.77 - 4.34), prior sepsis (OR = 2.37; 95%CI: 2.69 - 9.13); indotracheal insertion route (OR = 2.71 p > 0.05); length of ventilators > 4 days (x^= 5.5; p = 0,018. 75%) Gram (-), microorganism were isolated, P.
aeruginosa was on top.Conclusion: The incidence, proportion and mortality rates was high. There was significant association between VAP and length of MV over 4 days.
Keywords: ventilator associated pneumonia, incidence, proportion, mortality, association
NHAN MOT TRU'QNG HQP VIEM DA SUN TAI PHAT TAI BENH VIEN TAI M O I HONG TRUNG U'QNG
Quach Thi Cin Bdnh vidn Tai Mui Hong Trung wang
Viem da sun tai phat - RPC (Relapsing Polychondritis) li benh viem hoac thoii hda he thdng, tiin triin, giy ton thuxyng kin dio ciu triic, chirc nang toin vpn cua sun, ca quan cam giac bipt hda, tim mach, thin va he thdng than kinh. Die diim lam sing cua benh da dang. Tuy timg vi tri bj tdn thwang nen cd thi gap a tit ca chuyen khca khac nhau. Niu benh chi bleu hipn rdi rac a timg vj tri thi rit khd chan doin va nghT tdi. Nhan mdt trwdng hgp tai khoa cap ciru benh vien Tai Mui Hpng TW, tdi di cap tdi chin doan vi xCr tri cin bpnh nay.
Tu- khoa: viem da sun tai phat
1. OAT
VAN D EViem da sun t i i phit RPC (Relapsing Poly Chondritis) l i benh viem hoac thoii hda he thong, tiin triin, giy ton thuang kin d i o c i u true, chu-c nang toin ven cua sun, ea quan cam giic biet hda, tim mach, thin va he thing thin kinh. NhCrng hiiu biit v i nguyen nhin va bdnh sinh cua RPC dugc bio c i o mdt cich rdi rac d t i t ca cie chuydn khoa. D i e diem lim sang cua benh da dang. Tiiy tirng vj tri bj ton thuang nen cd the gap d t i t ca chuyen khoa khic nhau. Niu bdnh chi bieu hien rdi rac d tCrng vj tri thi r i t khd chin doin va nghT tdi. Trong chuyen khoa Tai Mui Hpng, benh nhin thudng tdi vdi biiu hien viem sun vinh tai, viem sun vung mui, viem thanh khi p h i quan. Nhan mdt trudng hgp tai khoa c i p eCru benh vien Tai Mui Hpng TW, tdi de cap tdi chin doin v i xu- tri cin benh niy.
II. MQTACABENH
1. Benh sir
Bdnh nhin Pham H i T, nu' 37 tuoi, vio vien vi khin tiing, khd thd, biin dang sun vinh tai.
Benh dien biin tCr thing 8/2001. Khdi dau, benh nhin xuit hien sung dau vinh tai, hai ben ty nhien, ed ehd s i n ngCra, da dugc chin doin vi diiu trj vidm sun vinh tai sau v i nhi thiy tieu hit sun vinh tai, da vinh tai ru xudng. Thing 2/2002, benh nhan dot ngdt ho, khd thd du- ddi, khdng sot;
da dugc md khi quan c i p cu-u tai bdnh vidn Tai - Mui - Hpng Trung uang v i soi thanh khi quan thay cd seo hep thanh khi quan, benh nhin dugc deo ong thd v i nhi. Nam 2003, BN ty phit hien song mui bj s i p xudng, khdng sdt, khdng sung ndng do dau. Sau dd, bdnh nhan thd qua eanuyl v i thudng xuit hien 1 - 2 dgt ho, khd thd c i p tinh trong nim.
